The distribution between hematopoietic bone marrow and fatty bone marrow in normal bone marrow may change with age, and T1 relaxation time of MRI (T1) is useful for quantitative measurement of these distributions. Since there have been almost no reports on T1 of the lumbar spine and pelvic bone, we examined T1 measurements of adult bone marrow (lumbar spine and pelvic bone) using the turbo FLASH method, and compared the differences by age, sex, and site. The subjects were patients and healthy volunteers including 74 males and 147 females without anemia. As a result, shortening of T1 with age was confirmed in both male and female subjects, with female subjects showing a higher correlation, compared to males. In addition, T1 of the pelvic bone was shorter than that of the lumbar spine and was significantly longer in female subjects aged 50 years or younger. Further differences in age and sex were also observed in young female subjects. Since the turbo FLASH method used in this study enables us to perform the T1 measurement in a short period of time, the burden on the subjects would likely be decreased.
A 38-year-old female was referred to our hospital with proteinuria. She had exhibited a urinary abnormality for the past 16 years since she was 22 years of age. She was diagnosed with IgA nephropathy of the good prognosis group based upon histological examination. Therefore, she was not treated at that time except for undergoing tonsillectomy for prevention of focal tonsillar infection. After 16 years, she was again reported due to her continuous proteinuria. A second biopsy revealed advanced IgA nephropathy without indication of glucocorticoid treatment. This evidence suggests that tonsillectomy alone was not sufficient to regulate the progression of IgA nephropathy but might mask the progression of glomerulonephritis.
Human herpes virus 6 is a common cause of exanthema subitum in children. Recently, isolated cases of human herpes virus 6 encephalopathy have been reported. We report a case of a 10-month-old boy with acute infantile encephalopathy predominantly affecting the frontal lobes associated with human herpes virus 6. He exhibited convulsive status epilepticus with hyperpyrexia. High signal intensity was evident in the cortex of both frontal lobes on diffusion-weighted magnetic resonance imaging, and decreased perfusion was noted in both frontal lobes with single-photon emission computed tomography. He subsequently developed regression of verbal and motor function, and atrophic changes were observed in both frontal lobes on T1-weighted magnetic resonance imaging. These characteristic findings may reflect a pathogenic mechanism in acute encephalopathy associated with human herpes virus 6.
Advanced gastric cancer is one of the common diseases that can be treated at ordinary hospitals. However cardiac surgery can only be performed in a limited number of institutes. We experienced a case of advanced gastric carcinoma and left atrial myxoma that was immediately treated by close collaboration between two hospitals in cooperation with the Nihon University School of Medicine. After curative surgery for advanced gastric carcinoma, the left atrial myxoma was resected. Shortly after the cardiac surgery, ultrasonography showed hepatic metastases from the gastric carcinoma. Chemotherapy was initiated with CDDP/S-1. After the initiation of chemotherapy, the liver metastases decreased markedly in size. The patient continues to undergo out-patient treatment using S-1 with a good quality of life.
We report a case of hemorrhage from brainstem cavernous angioma that caused various symptoms including neurootological, gustatory and facial sensory disturbances. A man experienced nausea and numbness of his right ear. It was confirmed that the symptom were derived not from a peripheral lesion but from retrocochlear and brainstem impairment based upon the findings of the DPOAE, ABR, VEMP, caloric test, optokinetic nystagmus etc. We detected an area of retrocochlear lesion that was responsible for both the auditory and vestibular disturbances based upon detailed neurootological examination in addition to MRI findings, and showed that the impairment was improved one year later without specific treatment.
We report a rare case of hiatal hernia of the broad ligament of the uterus, of which only 79 cases have been reported in Japan. A 40-year-old woman with no medical history was admitted to our department for abdominal pain and vomiting. Abdominal CT scan revealed a dilated small intestine and ascites in the pelvis. She was admitted under the diagnosis of ileus. Her condition was not improved after one day of conservative therapy. Further examination showed complete stenosis of the intestine. Emergency operation was performed. Operative findings revaled an abnormal defect, 3 cm in size, in the right broad ligament of uterus, and that an ∼90 cm length of the ileum had impacted into the defect. Ischemic change was recognized. After 100 cm of the small bowl was resected, the defect was simply closed. The postoperative course was uneventful. The patient was dischaged on the 10th postoperative day, and has since remained asymptomatic.
A 66-year-old man with advanced cervical esophageal carcinoma and lymph node swelling of the neck underwent neoadjuvant chemoradiotherapy with 5-FU/CDDP. Primary tumor and lymph node swelling revealed remarkable responsiveness to chemoradiotherapy. The esophageal carcinoma disappeared and an irregular mucosal membrane was observed by endoscopy. Radical resection was performed in consideration of residual cancer at the cellular level. A free jejunal graft was used for reconstruction following removal of the pharynx, larynx, and cervical esophagus. Pathologic examination of the resected specimens revealed no malignant cells in the esophagus and lymph node. In this case, preoperative chemoradiotherapy was clearly effective for esophageal carcinoma.